Controlling Society's Troublesome Children

"[Increase in weight and BMI in children irrespective of the type of SGA treatment] remains of great concern given that childhood obesity can adversely affect nearly every organ system."
University of Montreal research study

"Some kids need these medications to function and to go to school and do well. I don't want people to stop their children's medication if they need it."
"But there are things parents can do to [ensure their children] live healthy lives and [to] prevent some of these side effects. They just need to ask."
"Often these kids will stay on these medications for years, and not be reviewed. We've had kids on them for over seven years."
Dr. Dina Panagiotopoulos, pediatric endocrinologist, B.C. Children's Hospital, Vancouver

"[Weight gains of] this enormous magnitude [can set children up for a future with diabetes and cardiovascular disease] This is a terrifying study."
"[Antipsychotics are being] wildly and recklessly overused, very often by primary care doctors with little expertise or time, under the influence of drug company aggressive marketing."
"It's a form of social control. It's medicalizing problems that are social problems."
"[In instances where extreme behaviour cannot be controlled by other means] that medication may be worth it, despite all the risks. But this should be a very last resort, not a first reflex."
Dr. Allen Frances, professor emeritus, Duke University, Durham, North Carolina

Potent antipsychotics given to children as young as two can lead to significant weight gain, according to new Canadian research into a class of drugs that one prominent American psychiatrist says are being used as tools of "social control."  Getty Creative Images

Researchers from the University of Montreal initiated a study in concern over side effects, whether one drug alone was prescribed, or switched or combined with other antipsychotics prescribed as treatment for children diagnosed with attention deficit hyperactivity disorder (ADHD), aggression and behaviour problems. They took samples of children's height, weight and blood, searching for side effects. And they discovered that after 24 months of antipsychotic treatment, the mean weight of those children increased by 28 pounds (12.8 kilograms).

Of the young people being followed, twenty-three percent became overweight or obese, with close to ten percent developing impaired fasting glucose, a precursor to developing diabetes. The frequency with which children diagnosed with "disruptive behaviour disorder" in ADHD were prescribed antipsychotic medications was found to go beyond mood disorders or actual psychotic conditions, even though national guidelines recommend that these drugs not be used for behaviour problems in children.

Yet children as young as two years of age are being prescribed these powerful drugs meant to be prescribed to adults with serious psychotic issues. Second-generation antipsychotics (SGAs) use for children with ADHD has undergone an exponential growth, prescriptions seeing an 18-fold increase in British Columbia alone in the years 1996 to 2011. Right across Canada in the time frame 2005 to 2009 there was a 114 percent increase in recommendations for children in the use of psychotic drugs to manage their disruptive behaviour.

At Hotel-Dieu de Levis hospital in Quebec 147 children between the ages of ten to sixteen were treated in the years 2005 and 2013, part of a program meant to track the metabolic effects of second-generation antipsychotics on being treated for the first time with these mood-altering drugs that were at one time reserved to treat schizophrenia in adults, and now being prescribed "off-label" for an unapproved age range to adolescent boys and girls and even younger children, for aggression and behavioral problems.

The SGA drugs marketed in Canada include clozapine, risperidone and quetiapine, none of which are authorized for use under age 18 other than aripiprazole, approved for the treatment of schizophrenia in 15 to 17-year-olds. The Montreal study marking the weight increase, published by the Canadian Journey of Psychiatry, warns of serious complications that include high blood pressure, fatty liver disease and increased risk of heart disease and stroke "from childhood onward".

Dr. Panagiotopoulos at B.C. Children's Hospital studied a theory that these drugs affect brain chemicals that function to control hunger and satiety, disrupting normalcy. Her research team found that the actual caloric intake is not seen to sufficiently account for the weight increase, leading to the suspicion that the drugs may affect a child's resting energy expenditure, so that they burn fewer calories. Her research confirms that antipsychotic drugs are now being prescribed to preschool children.

It is vital, she states, that children be monitored every three months during the first treatment year, and thereafter at least once annually. Dr. Frances at Duke University points out that in his experience the reckless overuse of these drugs often targets poor children and children in foster care, as a form of social control.